A recent study by Ford JJ et al. (2015) examined the progress of 300 patients with sub-acute and chronic back pain of six weeks to six months. Patients were split into two groups. The first received guideline-based advice about their low back pain and resuming normal activities. The second group, were given individual therapy and advice. Ford’s findings highlighted interesting physical and psychological trends with patient care.
What is Low Back Pain?
Low back pain is a particularly common symptom amongst the general population and in the sporting world. The staggering statistic is, 85% of us will experience low back pain at some point in our lifetime. In 50% of those cases, there will be more than one episode. So, there is no wonder it is one of the leading causes for sick days in the U.K.
In many cases making precise pathological diagnosis is difficult. Many pain-producing structures of the lumbar spine can cause low back pain. Such structures include, duramater, ligaments of the vertebral arches, vertebral venous plexus, muscles and fascia, laminae, vertebral bodies, annulus fibrous of intervertebral disk, and apophyseal joints.
What Ford et al. Found
The main finding of the study was that patients who receive individualised therapy essentially exhibited the best improvements over the course of the study. In the final month of the study, the advice only group took two more days off work. Ford found that generic treatments may be a factor in mixed results with patient outcome. Showing, individualised treatments are arguably more effective when treating low back pain.
So What Does This Mean For Us?
We need to stop putting up with low back pain! The ‘just live with it’ approach is not the way to go. Get to your therapist and get a treatment plan specific to you. You could be one less statistic of repetitive low back pain. Take days off work for holidays and events you enjoy, not because you need to rest due to your pain!
A recent study by Falvey et al (2010) examined the anatomy of the IT band on 20 cadavers and tested various IT Band stretches. Their findings raise questions regarding the efficacy of many traditional treatment methods for conditions such as Iliotibial Band Syndrome and Patellofemoral Syndrome.
What is the Iliotibial Band
The ITB is a thick fibrous band which is an extension of the Tensor Fascia Lata muscle, but also receives most of the tendon of the Gluteus Maximus. It runs from the Iliac Crest to Gerdy’s tubercle on the lateral Tibia and has an attachment along virtually the full length of the femur (Falvey et al, 2010). It also connects to the Patella as it passes the knee.
What Falvey et al Found
The main finding of the research was that, even with an ideal IT band stretch, there was virtually no elongation of the IT Band – only about 2mm, which was an overall change in length of less than 0.5%. So basically, the IT Band is like an old piece of leather that is extremely rigid and resistant to stretch. The authors emphasize that current treatment protocols focusing on reducing tension in the IT Band are inappropriate and, that if our goal is to reduce tension on the lateral aspect of the thigh, we must focus on treating the muscular component of the Band.
So What Should We Do?
We need to STOP smashing our IT bands with massage and foam rollers, STOP trying to stretch the IT Band directly (which was extremely difficult to stretch correctly anyway!), and START focusing on the muscular component of the Band (Tensor Fascia Lata and Gluteus Maximus) which can be easily elongated by massage and stretching. I’ll be looking specifically at what the research says about Iliotibial Band Syndrome and Patellofemoral Syndrome in upcoming posts.
Blog written by Ross Harris of NIPysiotherapy.